TOMAS QUINN
Dependent on policy B03M000884
Claims
2
Attributed to this person
Charged
812.00
Total submitted
Denied
812.00
2 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | TOMAS QUINN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000884 |
| Date of birth | 10 Jul 1982 |
| Plan | PLATINUM PPO |
| Covered from | 11 Feb 2025 |
| Covered to | 11 Oct 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003823 | 9 Feb 2025 | 745.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 745.00 |
| CLM0003824 | 5 Feb 2025 | 67.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 67.00 |